米非司酮联合米索前列醇在孕8-10周无痛人工流产中应用的临床研究

发布时间：2018-04-26 07:37

本文选题：无痛人工流产 + 米非司酮　；参考：《山东大学》2013年硕士论文

【摘要】：目的：探讨在8-10周无痛人工流产术前采用米非司酮与米索前列醇预处理的临床疗效及安全性。方法：选择2013年1月-2013年6月就诊于滕州市工人医院妇产科计划外妊娠要求行人流术的8-10周早孕患者。符合纳入及排除标准的100例,均为预约手术,术前禁食水6-8h。将患者随机分为两组：研究组与对照组,每组各50例。研究组在对照组基础上术前晚8时空腹口服米非司酮150mg(6片),第2日晨8时在芬太尼联合丙泊酚静脉麻醉下实施无痛人工流产术,术前半小时舌下含化米索前列醇片400ug(2片)。对照组：直接采用芬太尼联合丙泊酚实施无痛人工流产术。流产前签署药物、手术、麻醉知情同意书。观察两组镇痛效果、宫颈扩张程度、麻醉药用量、手术时间、术时出血量、术后离床时间、及术前、术后宫腔大小、子宫收缩幅度以及术中术后并发症发生率(人工流产综合反应、漏吸、人工不全流产、宫腔宫颈粘连等)、术后阴道流血时间、月经复潮时间,对两组手术效果及安全性进行比较。(该方法的使用是在患者充分知情及严密的临床监控下进行的)。结果：研究组0级疼痛及宫颈扩张程度明显优于对照组。(1)麻药用量：研究组9.62±0.56m1,对照组13.08±1.03m1,差异有统计学意义,p0.05；术后离床时间：研究组7.54±0.67min,对照组12.32±1.39min,差异有统计学意义,p0.05;(2)术时出血量：研究组16.59±4.38m1,对照组20.39±5.77m1,差异有统计学意义,p0.05;手术使用时间：研究组3.42±0.26min,对照组4.38±0.43min,差异有统计学意义,p0.05；(3)术前、术后宫腔深度及子宫收缩幅度：研究组10.21±0.51cm、8.37±1.38cm、1.86±0.31cm,对照组10.74±0.49cm、9.59±1.38cm、1.58±0.38cm,差异有统计学意义,p0.05；(4)两组患者术后阴道流血时间有统计学意义,p0.05；(5)研究组患者术后月经复潮时间短于对照组差异有统计学意义,p0.05(6)研究组与对照组术中术后并发症比较差异无统计学意义,p0.05。结论：在8-10周无痛人工流产前采用米非司酮与米索前列醇预处理,具有软化宫颈,减少麻醉药物的用量、术中出血量,缩短手术时间,促进子宫收缩,术后出血时间短,月经复潮快的优点,可作为8-10周无痛人工流产前的常规预处理,值得推广。
[Abstract]:Objective: to investigate the clinical efficacy and safety of mifepristone and misoprostol preconditioning before 8-10 weeks painless induced abortion. Methods: from January 2013 to June 2013, patients with 8 to 10 weeks of early pregnancy who were admitted to Teng Zhou Workers' Hospital for ectopic pregnancy were selected from January 2013 to June 2013. 100 patients who met the criteria of inclusion and exclusion were all scheduled for operation and fasting water for 6-8 hours before operation. Patients were randomly divided into two groups: study group and control group, 50 cases in each group. The study group took mifepristone 150mg(6 tablets on an empty stomach at 8 pm before operation on the basis of the control group, and painless artificial abortion was performed under intravenous anesthesia of fentanyl and propofol at 8 am on the 2nd morning. 400ug(2 tablets of misoprostol tablets were sublingual for half an hour before operation. Control group: fentanyl combined with propofol was used for painless induced abortion. Sign informed consent to medication, surgery and anesthesia prior to abortion. The analgesic effect, the degree of cervical dilatation, the dosage of anesthetic, the time of operation, the amount of bleeding during operation, the time of leaving the bed after operation, and the size of uterine cavity before and after operation were observed. The amplitude of uterine contraction and the incidence of intraoperative and postoperative complications (synthetic reaction of artificial abortion, leakage of aspiration, artificial incomplete abortion, uterine cavity cervix adhesions, etc.), postoperative vaginal bleeding time, menstrual resuscitation time, etc. The effect and safety of operation were compared between the two groups. The use of this method is carried out with the patient's full knowledge and close clinical monitoring. Results: the level of pain and cervical dilatation in the study group was significantly better than that in the control group (9.62 卤0.56m-1, 13.08 卤1.03ml, P 0.05), and the time after operation was 7.54 卤0.67min in the study group and 12.32 卤1.39min in the control group. The amount of bleeding in the study group was 16.59 卤4.38m-1, the control group was 20.39 卤5.77m1.The operative time was 3.42 卤0.26min in the study group and 4.38 卤0.43min in the control group. Postoperative uterine cavity depth and uterine contraction amplitude: the study group (10.21 卤0.51cm) 8.37 卤1.38 cm (1.86 卤0.31 cm), the control group (10.74 卤0.49 cm) 9.59 卤1.38 cm (1.58 卤0.38 cm) the difference was statistically significant (p 0.05) the time of postoperative vaginal bleeding in the study group was significantly shorter than that in the control group (P < 0.05). There was no significant difference in intraoperative and postoperative complications between the study group and the control group (P 0.05). Conclusion: the pretreatment with mifepristone and misoprostol before 8-10 weeks painless induced abortion can soften the cervix, reduce the dosage of anesthetic drugs, shorten the operation time, and shorten the bleeding time after operation. The advantage of rapid menorrhagia can be used as routine pretreatment before 8-10 weeks painless induced abortion, which is worth popularizing.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R169.42

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